Refractory hypoxemia during support on venovenous (VV) extracorporeal membrane oxygenation (ECMO) is a challenging clinical problem. Manipulating ventilator settings, prone positioning, optimizing cannula position, and ECMO flows, and the use of beta blockers have been advocated as methods to improve oxygenation during VV ECMO.

Cannulation strategies designed to prevent mixing have also been reported.3 In patients with extremely high cardiac output, including those with trauma, sepsis, or other systemic inflammatory responses, these strategies may be inadequate or ineffective because the patient’s cardiac output may be substantially greater than the maximum flow achievable with an ECMO circuit. Here we report a novel strategy that was used to overcome refractory hypoxemia in a patient with high cardiac output.
Specifically, a second ECMO circuit was used in parallel with the first to achieve adequate oxygenation.